Home Call

When the first page came blaring through in the early morning hours of Monday morning, Gabriella’s exhausted brain integrated the noise into the dream she was having about being lost in the underbelly of a cargo ship. The blaring in the dream represented an alarm, which sounded with increasing urgency while dream Gabriella wove between the hulking metal shipping containers before finally waking with a start in her bed at home, drenched in sweat.  Her arm darted to her nightstand to silence the pager, while her brain tried to catch up and understand how she had gotten home and into bed despite not remembering anything after she pulled out of the parking garage around 11pm. 

 “Home call” was a strategy her surgery residency program employed to comply with the nationally mandated 80 hour per week limit on work hours while also providing full time resident coverage in the hospital on the weekends, which kept the attending surgeons slightly happier (she supposed, they still didn’t seem particularly content or well rested). This weekend she has operated all night Friday, because critically ill patients with surgical problems consistently present on Friday evenings, after seemingly out of spite staying home getting more and more sick all week. She didn’t have time to nap before rounding on forty inpatients and doing all of the associated orders, discharge, and notes work for them on Saturday, but had eaten dinner Saturday night and stolen a few hours of sleep before being called back in for an emergency surgery which lasted until Sunday morning rounds. Her nap Sunday afternoon had maddingly been interrupted by the apartment next door hosting a football watching party before she had been called back in Sunday evening to oversee the transfer of an unstable patient to the ICU. At least Sunday evening of call weekends brought the promise of almost having survived the weekend, and the bait of a coveted Saturday and Sunday off the following weekend.

Just as she was fumbling around in the sheets for her cell phone to return the page, the pager shrieked again, in an irregular rhythm that only happened when multiple pages were coming through at once. She blinked back tears, which came all too quickly when she was this tired. 

“They can’t stop the clock,” she reassured herself out loud, voice croaky with sleep, as she saw her bedside clock glowing 3:32am. Only two and a half more hours until she could hand the pager off to one of her co-residents and then promptly nap through their Monday morning teaching conferences.

Gabriella pressed the button, clenching her teeth in silent prayer that she wouldn’t see the emergency room’s number indicating yet another new patient to go in and see. She was an avowed atheist, except when she was on call. Clicking through the five new pages, she didn’t immediately recognize any numbers, which was unusual after months taking call. It was a relief though – surely if the emergency room and intensive care unit front desk weren’t paging her, nothing too bad could be going on.

After finding her phone under her pillow, she called the first number, one of the generic hospital operator number and a male voice answered.

“Hi it’s Gabby Barnes with surgery returning a page,” she said, for what felt like the thousandth time this weekend.

“Hi, it’s Sean. I’m over here on 6 east and I was just tidying up some paperwork and wondering if you could come sign the death certificate for Nathaniel—”

Gabriella cut him off. “Sorry I’m on home call, I’m not coming in just to do paperwork. If you leave it in the 8C workroom I can do it at sign out in a few hours.”

“Oh ok, I’m sorry to bother you, I hope I didn’t wake you up,” Sean replied. Gabriella rolled her eyes because of course he woke her up, it was 3:30am, but wasn’t too angry because she knew if Sean hadn’t woken her, the other four seemingly simultaneous pages that came through immediately afterwards  would have.

“Nope it’s ok, thanks bye,” she said, hanging up. A thought swirled in the back of her mind like a falling leaf – wasn’t her uncle Nathaniel, who lived across the country, in the hospital recovering from a stroke? Or had he discharged to a rehabilitation facility? She would have to remember to ask her mother.

She clicked through to the next page, a hospital number she didn’t immediately recognize. A woman who sounded young and frazzled picked up, saying hello. Why did they always put the inexperienced nurses on night shifts?

“Hi it’s Gabby Barnes with surgery returning a page.”

“Yeah hi, I’m so sorry to do this for you, but I just got a MCC admit in the ICU-“ the nurse started.

Gabriella cut her off with “I’m on for EGS, I don’t cover trauma. You need to page 43768.” 

“No, I know. I’m really sorry, but they’re tied up with a mass casualty. I think there was a shooting at a boarding school? Anyway I just need a PCA for this guy, he’s in so much pain and I can’t pull it from the cabinet without a signed order.  Please? I’ll put the rest of the admit orders in and have them sign it later, don’t bother with those.” the nurse pleaded.

Gabriella sighed. At least the nurse was acknowledging that she knew she wasn’t supposed to be calling, and it was actually a little surprising she wasn’t asking for all of the admission orders. Also a mass casualty shooting? Was she supposed to have gotten a mass casualty page? Dragging herself out of bed towards her computer, she replied “ok yeah sure. What’s the patient’s name?”

“Alex Jones, he’s in 18 in the SICU,” the nurse said.

Gabriella's chest clenched. Alex Jones was the name of her high school boyfriend, who had been killed by a drunk driver on a Sunday evening while riding his motorcycle home from work. What a strange coincidence.

“Do I need to come see him?” Gabriella asked.

“No, no, the trauma team saw him already, they just got called away before they could put orders in,” the nurse said.

“Okay, I’ll put in a morphine PCA.”

“Thank you so much,” the nurse replied, sounding genuinely grateful.

Gabriella shuffled into the living room, flopped down on the couch, and pressed the power button on her laptop which was resting on the coffee table. There was no chance she would forget that patient’s name, so she clicked to the next number on her pager while her laptop booted up.

It was her childhood phone number, the number of the house that burned to the ground when she was in fifth grade, forcing her family to move to a different school district. How was this number on her pager? Was it somehow linked to her name online? No one even knew it except for her parents and older brother, and maybe a few friends from elementary school who had written it down. She could not make sense of it showing up on her pager eighteen years later. The pager reminder beep sounded, interrupting her puzzled reverie. She clicked to the next number, another unfamiliar hospital number.

After dialing this number, Gabriella was greeted with a confidant, brisk, “Hello 15 west nurses station, please hold,” from a female voice and put on hold. After 20 seconds of silence, the phone disconnected with an audible click. Irritated, she called back immediately and there was no answer after she let it ring 20 times. Fine, they would page again if they needed her she was thinking at the moment she realized there was no fifteenth floor. The hospital was fourteen stories tall, with the patient floors divided into east and west. “Discharge to the fifteenth floor” was the euphemism the residents used when a patient died. Weird. Maybe a new unit clerk confused about that floor she was on?

There was still one unread page, and Gabriella clicked to that. It was “55555” which made a little bit of sense because all of the hospital extensions started with a 5, but she had never seen all fives. Maybe someone had fallen asleep while paging her, the way she sometimes fell asleep writing progress notes and woke up to a computer error noise and a screen full of whatever letter her finger was resting on? She smirked at this though. Five was her lucky number, and was it actually possible that she got paged five times in the middle of the night and all she was going to have to do was put in an order from home?

Gabriella called 55555 and before the phone even rang on the other end heard a brusque male voice, “please hold.” Sighing, she shifted her cell phone against her neck, trying to remember which order it was that she had said she would put in. The hold music played, an unidentifiable instrumental medley, except it wasn’t interrupted by the usual wellness announcements about healthy eating and getting enough sleep, which she found particularly maddening in the middle of the night on call. Maybe it was really was her lucky night. Thinking about luck, and music, and healthy foods that she wasn’t being reminded to eat, she slowly slumped down on the couch and drifted from consciousness…

“Gabby!” a loud voice said over a dull roar of background noise, shining a bright light in her eyes.      

Gabriella thrashed her head from side to side, trying to follow with her arms but finding them immobilized. She was slightly cool, and very confused, and could only manage to ask “where am I?” in a voice that didn’t sound like her own.

“Oh thank god,” the blurred oval above her face said, slowing coming into focus. “Airway intact!” she barked to the room. “Bilateral breath sounds,” someone else said. “Strong DP pulses bilaterally,” another person said. 

A kind, calm voice warm in her ear said, “Gabby you’re going to be ok. It’s early Monday morning. You were in an accident driving home but you’re in the hospital, we’re going to take good care of you.”